Mont Marie Rehabilitation & Healthcare Center

In the surveyor’s words

From the most serious findings on record at Mont Marie Rehabilitation & Healthcare Center, in the surveyor’s own words.

• Actual harm, isolatedF622Apr 4, 2025

  Based on interviews, and records reviews, the facility failed to provide appropriate notice of discharge for a facility-initiated discharge, when the Resident did not initiate a request of discharge for one Resident (#72) out of three closed records. Specifically, the facility failed to provide appropriate notice of discharge to Resident #72 when: -the facility determined that the Resident was acting Against Medical Advice (AMA) by driving his/her personal vehicle to a scheduled eye surgery appointment. -the facility notified the Resident he/she was discharged upon return to the facility from the scheduled eye surgery appointment. […]

• No harm, potential for more than minimal, patternF726Sep 6, 2022

  Based on observation, interview, and record review, the facility failed to ensure that its staff providing direct care and services to residents were assessed for the required competencies. Specifically, the facility failed to ensure that its staff provided evidence that licensed nursing staff competencies were assessed for care and services provided to residents who received hemodialysis ([CONDITION(S)] - mechanical process of purifying the blood for a person whose kidneys do not work normally), as required, according to the facility's policy for nursing staff competency and the Annual Facility Assessment, directly impacting Resident #25. […]

• No harm, potential for more than minimal, isolatedF641May 18, 2026

  Based on observation, interview, and record review, the facility failed to ensure Minimum Data Set (MDS) Assessments were accurately coded for two Residents (#52 and #22), out of a total sample of 18 residents. Specifically, the facility failed to:1. For Resident #52, accurately code a pressure injury that was present during the observation look back period and to identify the Resident as being at risk for developing pressure injury.2. For Resident #22, accurately code an identified pressure injury present on admission, when the pressure injury was coded as Stage 3 pressure ulcer and the admission nursing assessment indicated MASD (moisture associated skin disorder) to the sacrum. Findings include:1. […]

• No harm, potential for more than minimal, isolatedF686May 18, 2026

  Based on observations, interviews, and records reviewed, the facility failed to provide care consistent with professional standards of practice relative to pressure ulcers (localized damage to the skin and/or underlying soft tissue usually over a bony prominence or related to a medical or other device) for two Residents (#52 and #22), out of a total sample of 26 residents. Specifically, the facility failed to:1. for Resident #52, appropriately identify and communicate a sacral wound observed on admission to the Wound Provider timely, and also failed to implement the Wound Provider interventions for treatment and air mattress use pertaining to the Resident's sacral wound in a timely manner resulting in the sacral wound further deteriorating. 2. […]

• No harm, potential for more than minimal, isolatedF698May 18, 2026

  Based on observations, interviews, and records reviewed, the facility failed to ensure that dialysis care consistent with professional standards of practice was provided for one Resident (#11) out of a total sample of 18 residents. Specifically, for Resident #11, the facility failed to:-accurately update the change in access site from the PermCath to the left upper arm fistula (when the Resident had a right chest PermCath and left upper arm fistula [vascular access that is created surgically by connecting an artery and a vein]) for dialysis treatments.-provide ongoing assessment of the patency of the Resident's left upper arm fistula vascular access for thrill (vibration felt) and bruit (swishing sound), to prevent complications related to the vascular access site. […]